By: Dr. Iqbal Elyazar (OUCRU Indonesia)

Malaria is not just a public health issue; for the tourism industry, it represents a grave threat to reputation and economic sustainability. A single outbreak in a tourist destination can instantly slash visitor numbers, erode investor confidence, and damage a brand image built over decades. Economically, the cost of control is far lower than the potential losses. For instance, the cost of providing bed nets and Indoor Residual Spraying (IRS) for one lodging is estimated at less than IDR 100,000 per year, whereas a mere 10% drop in visitors equates to a loss of IDR 250–500 million per year in local tourism revenue.

The urgency of this topic is highlighted by the OECD Tourism & Health report, which indicates that malaria prevention costs in tropical areas typically account for only 0.3% to 1% of total local tourism income. In contrast, inaction can lead to a 40% decline in visits. The success of destinations like Zanzibar, Southern Thailand, and Fiji in eliminating malaria proves that a "Malaria-Free" status provides an economic bonus, with visitor numbers increasing by 20-30% shortly after interventions.

Ecological Context and Coastal Epidemiology

Coastal regions and small islands, such as those in Lampung (Pahawang Island, Kiluan Bay, and the Pesawaran coast), possess unique ecological characteristics that strongly support malaria transmission. These ecosystems provide ideal breeding grounds for coastal-specific vectors like Anopheles sundaicus and Anopheles subpictus, which thrive in brackish water, lagoons, and degraded mangroves. Unplanned infrastructure development often creates new puddles or plastic waste that collects rainwater, further expanding these vector habitats.

Epidemiologically, while national trends show a decline in cases, endemic pockets persist in coastal areas with Annual Parasite Incidence (API) ranging from 0.5 to 3 per 1,000 population. Plasmodium vivax is the dominant parasite in these areas, posing a significant challenge to elimination due to its ability to relapse. Vulnerability is exacerbated by tourism patterns dominated by nighttime outdoor activities, such as bonfires or camping, which increase travelers' exposure to mosquito bites.

Population Mobility and Integrated Control Strategies

Malaria risk in maritime destinations is heavily influenced by population mobility. Travelers often arrive from non-endemic areas without protection, experience brief exposure, and potentially carry the parasite back to their hometowns (imported cases). Conversely, migrant or seasonal workers in the tourism sector often stay for long periods in crowded housing vulnerable to infection. Therefore, control strategies must go beyond permanent residents and include the entire "mobile population."

Proposed strategies include strengthening active and passive surveillance by placing trained microscopists on major tourist islands and conducting periodic mass screenings of tourism workers. The distribution of Long-Lasting Insecticidal Nets (LLINs) to homestays and lodgings must become an operational standard, accompanied by IRS. Environmentally, managing salinity in brackish water and filling in stagnant water are key. An innovative approach that has been tested is the training of specific malaria cadres in tourism areas, such as in Rajabasa, South Lampung. This community-based program has proven effective in keeping visitor numbers stable at an efficient cost.

Recommendations and Cross-Sector Collaboration

Eliminating malaria in maritime tourism destinations requires genuine collaboration. Health Departments are responsible for diagnosis and logistics, while Tourism Departments must integrate health standards into lodging accreditation. Local governments could allocate a portion of tourism levies to fund health programs sustainably. Furthermore, digital risk communication via tourism apps and social media is vital to increase traveler awareness. By establishing Lampung as a model for "Healthy Tourism," we protect not only the local community but also ensure long-term economic protection for Indonesia’s tourism industry.

Note: This material is the presentation content by Dr. Iqbal Elyazar (OUCRU Indonesia) for the webinar Malaria Risk in Travel: Hidden Threats in Maritime Destinations held on May 5, 2026.

Download the full presentation material (English): Download PPT - Maritime Malaria Risk